Dr. Mansi gave an excellent lecture on cancer screening today. His talk cited an interesting article from the British Medical Journal. The authors discuss the notion that cancer screening has never been shown to reduce overall mortality, only disease specific mortality. They postulate two main explanations for this observation: under-powered clinical studies and deaths due to the downstream effects of screening. Although disease specific mortality reductions are important, “off-target deaths” may negate the these gains especially for screening modalities that lead to invasive treatment and testing. Providers must be aware of the established goals of cancer screening. This is essential for rational clinical practice and patient counseling. Furthermore, the article outlines important questions for future research and necessary improvements to cancer screening study design.